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BT202190: Coverage and billing information for the October 2021 HCPCS code update
Effective date
Oct 1, 2021
Identified
Jun 19, 2026
Summary
The IHCP published coverage and billing information for the October 2021 HCPCS update, effective retroactively to dates of service on or after October 1, 2021 unless otherwise specified. The October 2021 HCPCS and CPT codes will be added to the claim-processing system, and established pricing will be posted on the appropriate IHCP fee schedule. Covered status, prior authorization and NDC requirements, and prior authorization criteria are listed for the new codes, along with alternate codes for discontinued codes.
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What to do
Action · 9 steps
01Already effective October 1, 2021: for claims with an earlier effective date, providers had 90 days from the September 30, 2021 publication date for managed care claim submission, or 180 days for fee-for-service claim submission, to bypass timely filing limits.
02Include a copy of the bulletin (first page only) when submitting claims beyond the standard filing limit.
03Check current applicability before relying on these time frames.
04Billing team: for fee-for-service prior authorization questions, contact Gainwell Technologies at 800-457-4584, option 7; for managed care prior authorization questions, contact the member's managed care entity.
05Meet the prior authorization criteria in Table 6 for codes that require prior authorization.
06Q0240 will be paid at zero until further notice.
07Codes A4453, K1024, K1025 and K1027 are included in the LTC facility per diem rate.
08Use the alternate codes for discontinued codes, such as J1426 in place of C9075 and J9318 in place of C9065.
09Documentation for codes such as S9432 requires medical necessity support for special nutrients.
Codes mentioned
A4453C1831C9081C9082C9083C9084C9779C9780J0699J0741J1305J1426J1445J1448J2406J7294J7295J9247J9318J9319K1021K1022K1023K1024K1025K1026K1027M0240M0241P9025P9026Q0240Q2054Q4251Q4252Q4253Q9004S9432C9065C9075C9076C9077C9078C9079C9080J0693J7303J9315
Original notice
BT202190: Coverage and billing information for the October 2021 HCPCS code update
in.gov · Always check the source before changing claims.
Related changes
See all Indiana Medicaid (IHCP) changes →BT202156: Coverage and billing information for the July 2021 HCPCS code updateMediumEffective Jul 1, 2021 · Claims & BillingBT202425: Revised coverage and billing information for the 2024 annual HCPCS codes updateHighEffective Jan 1, 2024 · Claims & BillingBT202476: IHCP updates HIP preventive care services exempt from copaymentHighEffective Jul 1, 2024 · Managed CareBT202537: IHCP removes coverage for certain COVID-19 treatment procedure codesMediumEffective Dec 13, 2024 · Medical PolicyBrowse every Indiana Medicaid (IHCP) change in the policy list
Related policy hubs
Indiana Medicaid (IHCP) policiesIN policy changesOncologyInfectious DiseaseNeurologyCardiologyWound CareCode A4453Code C1831Code C9081Code C9082Code C9083Code C9084Code C9779Code C9780Code J0699Code J0741Code J1305Code J1426Code J1445Code J1448Code J2406Code J7294Code J7295Code J9247Code J9318Code J9319Code K1021Code K1022Code K1023Code K1024Code K1025Code K1026Code K1027Code M0240Code M0241Code P9025Code P9026Code Q0240Code Q2054Code Q4251Code Q4252Code Q4253Code Q9004Code S9432Code C9065Code C9075Code C9076Code C9077Code C9078Code C9079Code C9080Code J0693Code J7303Code J9315